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Liquor License Transfers Rotary ClubABD Licensing -Applicant Home Contact Us Logoff Help License Search ~~, License List State otl~wa 3~Ei+n~ ~~ ' F €~ On-Demand Key Registration ..Reporting. Search Page 1 of 1 Applicant BW0092633, Rotary Club of Dubuque, Dubuqu ~' Applicant ,._...._ -_.,..~ -. ___....... WW_~___,_ Transfer Premise After completion click on the NEXT link to continue to the next screen, ar the BACK link to returr The navigation links on the top may also be used to move around the application. ~ New Prem~~e Location Information aa- Applicant Signature Name of Applicant: Rotary cit,r~ of DuF~~que (Sole Proprietorship, F Name of Business (D1BIA): Rotary Cltll~ of t~~ikau~ue ~ Dram Cert Address of Premise: 135 VV. 8th it. Local Endorse Address Line 2: City: C~ubuque County: C~ubuc~t~e Zip: 52001 Business Phone: (563} 580-2234 Cell I H Sartre Artdress Mailing Address; F'.Q. E~C~x €313 Mailing Address Line 2: City: IOub~lue Zip: x.2004 Contact Name: Mike Phone: X563} a84-0235 Em i Prev Phone: (866) 469-2223 FAX: (515) 281-7375 https://eicensing.iowaabd.com/Applicant.aspx 08/28/2007 ABD Licensing -Transfer Premise Home Contact Us Logoff ~i~ Help License Search (! License List ~t~te ~f (t~.ra ~;~U t; On-Demand 'r(t.g Registration User Prafile Re ortin Search i ~ -. p 9 ___ _._...W __ ~ _.~,...__.._ . -_ ._.., Page 1 of 1 applicant Transfer Premise BW0092633, Rotary Club of Dubuque, I Transfer Premise After completion click on the NEXT link to continue to the next screen, ar the BACK link to returr New Premise Location Information The navigation links on the top may also be used to move around the application. Applicant Signature Licenses may be firansferred from one location to another, but anly within the boundaries of the Transfer Applicatian and all supporting documentation shall be approved by the Local Official ai ~~ Dram Cert Beverages Division before the event takes place. All selling and serving of alcoholic beverages r Local Endorse location during the period of the transfer. NOTE: If requesting a permanent transfer, an amender Official. If requesting a temporary transfer, a letter of permission will be forwarded to the Local E Name of Applicant: Rotary Club of Dubuque Name of Business (D!B!A): Rotary Club of Dubuque Address of Premise: 135 W. 8th St. Address Line 2: City: Dubuque County: Dubuque New Premise Address: 1000 Jackson St New Premise Address Line 2: -,- State: ~ City: Dt,cbtaque Iowa f: Temporary Transfer (24 hours through 7 days) Beginning Date: 09/15/2007 i Prev Phone: (866) 469-2223 FAX: (515} 281-7375 t"" Permanent Transfer Beginning Date: https://eicensing.iowaabd.com/TransferPremise.aspx 08/28/200 ABD Licensing -New Premise Location Information ~ Home State 0(EoWe =~ c~* ~, ~ Contact Us ti , ~ i d ~ ~ ~~ ~~~ Logoff - ~~ n~, f ~ ~' e i' .7as_ Help License Search ' License List On-Demand Keg Registration _ Reporting ___.__ Search ~' Applicant ~~ Transfer Premise New Premise Location Information Applicant Signature E, Dram Cert Local Endorse Page I of I :~ ~,~ ~i ~'t. User Profile I New Premise Location Information BW0092633, Rotary Club of Dubuque, Dubuque After completion click on the NEXT link to continue to the next screen, or the BACK link to returr to the previous screen. The navigation links on the top may also be used to move around the application. ~~ # of Bathrooms: ~ Number of floors where alcoholic beverages will be sold, served, consumed ar stared. Indicate how you have control of premises (Permanent Transfers Only}: C` Own C' Lease Submit tp the Local Autharity a signed copy of the lease/rental agreement for the license period signed final sales contract or warranty deed. Submit to the Local Authority a sketch on 8112 x 11"white paper of the proposed premises showing all areas and floors where alcoholic beverages will be sold, served, consumed and stared. Indicate all entrances and exits, location of bar, back bar and bathrooms. If Applicant ha: Outdoor Service Area Privilege, please include in the sketch its relationship to the licensed premises. Outdoor Service _....._. Area Dates (if From: MM/DDIYYYY To: MMIDDIYYYY applicable}: Dates shall correspond with requested outdoor service areas. On-Premise Applicant's Only: Yes ~~ Is the premise furnished with tables and seats to accomodate a minimum of 2 persons at one time? °~ Prev Next Phone: (866} 469-2223 FAX: (515) ::$1-7375 Terms of Servi Privacy Poli https://elicensing.iowaabd.com/NewPremiseLocationInformation.aspx 08/28/2007 ABD Licensing -Applicant Signature Home St9tf? tIf law9 ~: t.> }~x r:.:, .:, . Contact Us n ; a I~~ 1 ~ f " '~ '' Logoff ~.~r~-. t>~ ~ .P ~... y^R Flelp License Search License List On-Demand Keg Registration Reporting _ Search Applicant Transfer Premise New Premise Location Information ~ Applicant Signature ~ Dram Cert ~~ Local Endorse Page 1 of 1 ~~~ ~w~ ~~ ~f . ~'/i ~}•)~' User Profile __. _ __.._ i_ Applicant Signature BW0092633, Rotary Ciub of Dubuque, Dubuque Complete the information below and click Finish to complete the application Nate that the license fees will only be withdrawn from accounts after the Af3D approves the license. This application must be completed by a person listed in the Ownership Section. E hereby declare that all information contained in the Applica#ion is true and correct. I understand that misrepresentation of material facts in the Application is a crime and grounds far denial of the license or permit under Iowa law. 1 further understand that, as a condition of recieving a license, the licensed premise is subject to inspection during business hours by appropriate local, state and federal officials. NOTE: The Applicant's Name must match one of the owner's names from the Ownership screen. Applicant's Name: Army tlV~ber Date: 08/2312t~07 ~~~ MMlDD/YYYY Tentative effective date: G9!1 ~,QOi._..._.._.._._. MMlDD/YYYY Phone: ($66} 469-2223 FAX: {515} 2$1-7375 Please print a copy of this page for your records before clicking the '"FINISH" button. ~~... . Terms of Service Privacy Policy https://eicensing.iowaabd.com/ApplicantSignature.aspx 08/28/200 ABD Licensing -Applicant Home Contact Us Logoff Help ' ' License Search ..State of lo~,va 3 a9€11~j~i T~'Y . ~ ,,' License List Reporting........... Kcg Registration Page 1 of 1 Applicant ~^ Transfer Premise New Premise Location Information Applicant Signature Dram Cert ~ Local Endorse Applicant BW0092633, Rotary Club of Dubuque, Dubuqu After completion click an the NEXT link to continue to the next screen, ar the BACK link to returr The navigation links on the top may also be used to move around the application. Name of Applicant: Rotary Cl~~b cif f7t~bc~Ll~ {Sole Proprietorship, F Name of Business {D161A): Rotary Itlb cif D~,~iauque Address of Premise: ~ 35 . 8th fit. Address Line 2: City: C?ubUC~~I~ County: ~~~-Iq~~~ Zip: x2061 Business Phone; {563) ~£~~-2234 Cell / H r Same Address Mailing Address; P.C). E3c:x 813 Mailing Address Line 2: City: Dubl~r~~~e Zip: 52Q04 Contact Name: dike Phone: X563) 584-9235 Em :." Prev Phone: {866} 469-2223 FAX: {515} 281-7375 https://eicensing.iowaabd.com/Applicant.aspx 08/28/2007 ABD Licensing -Transfer Premise Home 8t;~t~ ~t itt~nra Contact Us ~ 3 ~~ ~ ~ ~ ~, Logoff ~ j+ ~^- 1"I~ip License Search ~ License List On-Dernanci _L Reporting._., Page 1 of 1 ''r Keg Registration Applicant Transfer Premise BW0092633, Rotary Club of Dubuque, I ~ Transfer Premise After completion click on the NEXT link to continue to the next screen, or the BACK link to returr New Premise Location Information The navigation links on the tap may also be used to move around the application. ~ Applicant Signature Licenses may be transferred from one location to another, but anly within the boundaries of the Dram Cert Transfer Application and all supporting documentation shall be approved by the Local Official ac Beverages Division before the event takes place. All selling and serving of alcoholic beverages r Local Endorse lacatian during the period of the transfer. NOTE: If requesting a permanent transfer, an amendee Official. if requesting a temporary transfer, a letter of permission will be forwarded to the Local C Name of Applicant: Rotary Club of Dubuque Name of Business (DIB/A): Rotary Club of Dubuque Address of Premise: 135 W. 8th St. Address Line 2: Gity: Dubuque County: Dubuque New Premise Address: 1000 Jackson St New Premise Address Line 2: State: City: C"~~ahuque ~ lo~~r~ is Temporary Transfer (24 hours through 7 days) Beginning Date: 09/22/2007 `? Prev Phone: (866) 468-2223 FAX: (515) 281-7375 f" Permanent Transfer Beginning Date: https://eicensing.iowaabd.com/TransferPremise.aspx 08/28/2007 ABD Licensing -New Premise Location Information Home Contact Us Logoff ~ket>~ oI toava Q~i~~~i~+~~' Fw 3"r ~ y` k ~ ' ?~ Page 1 of 1 ~ ~~:~ ~, .,~~f ' r~~. ~. User Profile ~~ ,~~ Help License Search License List OFD.Demand Keg Registration Reporting Search Applicant ~ Transfer Premise New Premise Location Information Applicant Signature Dram Cert Loco! Endorse New Premise Location Information BWOO92633, Rotary Club of Dubuque, Dubuque After completion click an the NEXT link to continue to the next screen, or the BACK link to returr to the previous screen. The navigation links on the top may also be used to move around the application. # of Bathrooms: ~ Number of floors where alcoholic beverages will be sold, served, consumed ar stored. Indicate how you have control of premises (Permanent Transfers Only}: t Own t Lease Submit to the Local Authority a signed copy of the leaselrental agreement for the license period signed final sales contract ar warranty deed. Submit to the Local Authority a sketch on 8112 x 11"white paper of the proposed premises showing all areas and floors where alcoholic beverages will be sold, served, consumed and stored. Indicate all entrances and exits, location of bar, back bar and bathrooms. If Applicant ha: Outdoor Service Area Privilege, please include in the sketch its relationship to the licensed premises. Outdoor Service Area Dates (if Fram: MM/DDlYYYY To:~~~~~ MMlDDlYYYY applicable}: Dates shall correspond with requested outdoor service areas. On-Premise Applicant's Only: Yes Is the premise furnished with tables and seats to accamodate a minimum of 2 persons at one time? Prev Next Phone: ($66} 459-2223 FAX: (515} 2$1-7375 Terms of Servi Privacy Poli https://eicensing.iowaabd.com/NewPremiseLocationInformation.aspx 08/28/2007 ABD Licensing -Applicant Signature Page 1 of 1 ~ Home ~St~te Of ~p:vit ~' 'M m n~~d I~ ~1 ~ Contact Us ~. ~~~''" a ' ~~'~ ~ x ;~'r.~' Logoff n 1 ~~~ ~~' e ~ F 1~' ~ • ~ z~ ., _ . :, _ ~ ~ ~ .~ F f .. ..~___...,.....__....,~.m. ~On-Demand Kty Registration ! UserProfrle Help i.-cense Search License List Reporting Search _._ ~, ' Applicant Transfer Premise ~ New Premise Location Information ~ Applicant Signature ~ Dram Cert ~ Local Endorse Applicant Signature BW0092633, Rotary Club of Dubuque, Dubuque Complete the information below and click Finish to complete the application Nate that the license fees will only be withdrawn from accounts after the ABD approves the license. This application must be completed by a person listed in the Ownership Section. I hereby declare that all information contained in the Application is true and correct. I understand that misrepresentation of material facts in the Application is a crime and grounds for denial of the license or permit under Iowa law. I further understand that, as a condifiion of recieving a license, the licensed premise is subject to inspection during business hours by appropriate locat, sta#e and federal officials. NOTE: The Applicant's Name must match one of the owner's names from the Ownership screen. Applicant's Name: Army ~I~leber_ Date: 0812312t~07 MM/DDIYYYY Tentative effective date: C?9122;~ QC}? MMIDD/YYYY Phone: (866) 459-2223 FAX: (515) 281-7375 Please print a copy of this page for your records before clicking the "FINISH" button. F ~m 4'd. -.~a' Prev Terms of Service Privacy Policy https://eicensing.iowaabd.com/ApplicantSignature.aspx 08/28/2007 ABD Licensing -Applicant Page 1 of 1 Home Stat@ 0# IG~~~ ~ ~ r ~i.~~~'~ ~' ~ ~.,;~.~ ~ Lo Hoff t Us _ ~ ~ ~ ~ ~t ~~~ y ~ a ~ ~ ~ ~ `~ : ~ _ ':~ %' ~ . ~.: ©n-Demand Kc:g Registration Help License Search License List User Profile Reporting _ Search Applicant Transfer Premise New Premise Location Information Applicant : ignature Dram Cert ~ Local Endorse Name of Applicant: £~t~r~ Gl~lk} of I~u~Ur~ie {Sale Proprietorship, F Name of Business (D/B!A): 1~c~tary ~lu~s of D~ibur~ue Address of Premise: 135 UV. 8th Bt. Address Line 2: City: Dubtaque County: [~ubuq~xo J Zip; 520Q1 Business Phone: (563 5£39-2234 Cell I H ar~ae Address Mailing Address: P.O. Box 813 Mailing Address Line 2: City: C~ubuq~ie Zip: ~JZDt~4 Contact Name: Mika Phone: {563} 584-9235 Em Phone: (866} 469-2223 FAX: (515) 281-7375 Applicant BW0092fi33, Rotary Club of Dubuque, Dubuqu After completion click on the NEXT link to continue to the next screen, or the BACK link to returr The navigation links on the top may also be used to move around the application. <.I Prev https://eicensing.iowaabd.com/Applicant.aspx 08/28/2007 ABD Licensing -Transfer Premise Page 1 of 1 E~€+,I~llr~ "~t~~k4~; :~ Home Stag of IQ~rra ~ Contact Us ~ ~ ~. ; ~~ ~ u t ~ ~ ~~i ~ ~ ' _~ Y ~ . <<~ ,.~" , Logoft ~. ~: _~ ._~ On-D~:mand Keg Regrstration Help License Search License List User Profile Reporting _ __ Search ~ ,,..__ _ ___... W_._ Applicant Transfer Premise BW0092633, RO#ary Club Of Dubuque, i ~ Transfer Premise After completion click an the NEXT link to continue to the next screen, or the BACK link to returr New Premise Location Information The navigation links on the top may also be used to move around the application. Applicant Signature Licenses may be transferred from one location to another, but only within the boundaries of the ~ Dram Cert Transfer Application and all supporting documentation shall be approved by the Local Official ar Beverages Division before the event takes place. All selling and serving of alcoholic beverages r Local Endorse location during the period of the transfer. NOTE: If requesting a permanent transfer, an amended Official. If requesting a temporary transfer, a letter of permission will be forwarded to the Local C Name of Applicant: Rotary Club of Dubuque Name of Business (D/BIA}: Rotary Club of Dubuque Address of Premise: 135 W. 8th St. Address Line 2: City: Dubuque County: Dubuque New Premise Address: 1000 Jackson St New Premise Address Line 2: City: C~~~but~e tl State: ~~ ~ it~~~==~ (~' Temporary Transfer {24 hours fihrough 7 days} Beginning Date: 09/29/2007 ~~~ i;!: Prev Phone: (866} 469-2223 FAX: (515} 281-7375 {"' Permanent Transfer Beginning Date: https://eicensing.iowaabd.com/TransferPremise.aspx 08/28/2007 ABD Licensing -New Premise Location Information ~ Home Contact Us Logoff Help License Search Page 1 of 1 State of Iowa =:~~~~ ~r ~~„ - ~ ' ... ~-" }, , . License List O~z-Demand Kuy Kegistration „ User Profile Reporting Search ,~ Applicant ~ Transfer Premise New Premise Location Information Applicant Signature Dram Cert ~ Local Endorse Phone: {8fifi) 469-2223 FAX: {515) 281-7375 New Premise Location Information BWOQ92633, Rotary Club of Dubuque, Dubuque "' After completion click on the NEXT link to continue to the next screen, ar the BACK link to returr to the previous screen. The navigation links an the top may also be used to move around the application. ~~ # of Bathrooms: ~ Number of floors where alcoholic beverages will be sold, served, consumed ar stored. Indicate how you have control of premises (Permanent Transfers Only): C" Own C" Lease Submit to the Local Authority a signed cagy of the lease/rental agreement for the license period signed final sales contract ar warranty deed. Submit to the Local Authority a sketch on 8112 x 11"white paper of the proposed premises showing all areas and floors where alcoholic beverages will be sold, served, consumed and stored. Indicate all entrances and exits, location of bar, back bar and bathrooms. If Applicant ha<, Outdoor Service Area Privilege, please include in the sketch its relationship to the licensed premises. Outdoor Service ,_,~. Area Dafies {if From: MM/DDlYYYY Ta: MM/DDIYYYY applicable): Dates shall correspond with requested outdoor service areas. On-Premise Applicant's Only: YeS ~ Is the premise furnished with tables and seats to accamodate a minimum of 2 persons at one time? Prev Next Terms of Servi Privacy Poli https://eicensing.iowaabd.com/NewPremiseLocationInformation.aspx 08/28/2007 ABD Licensing -Applicant Signature ~ Home 5t~t8 r)f lowa ~ Contact Us ~ Logoff ~:; Help License Search License List ReDortinnd ~.. . _ . ~. _ ~ ____. _ __ __ ~ -.. ._ _ ____p. _ .._..9._ Applicant ~ Transfer Premise ~ New Premise Location Information Applicant Signature Dram Cert ~ Local Endorse Page 1 of 1 r~; =;,,~'~'~''t ~ ` ~ , `~ r.; Keg Registration Search User Profile Applicant Signature BW0092633, Rotary Club of Dubuque, Dubuque Complete the information below and click Finish to complete the application Note #hat the license fees will only be withdrawn from accounts after the ABD approves the license. This application must be completed by a person listed in the Ownership Section. ( hereby declare that all information contained in the Application is true and correct. understand that misrepresentation of material facts in the Application is a crime and ', grounds for denial of the license or permit under tows law. I further understand that, as ', a cond'mtion of recieving a license, the licensed premise is subject to inspection during business hours by appropriate local, state and federal officials. NOTE: The Applicant's Name must match one of the owner's names from the Ownership screen. Applicant's Name: Arty ~IVeber Date: (18123/ZCi(}7 MMlDDlYYYY Tentative effective date: rJ912~12007~ ~ MMlDDlYYYY Phone: (866} 469-2223 FAX: (515} 281-7375 Please print a copy of this page for your records before clicking the "FINISH" button. [{ Prev Terms of Service Privacy Policy https://elicensing.iowaabd.com/ApplicantSignature.aspx 08/28/2007 ABD Licensing -Applicant Page 1 of 1 Home Stag Of }owa ~'; , ,~.r~+ ~~ ~ ~~-, Contact Us :; j'3 ~ ~ ~ ~ ~ t P ~ ~ y ~ Logoff ...,~ :~~ ~ ~ : `~~ ~.: . ~~ .i ~, .. , .~ ~_,__~.. ,~ ~3n-Demand Keg Registration Help License Search License List User Profile .~ __..._ ___ Reportir~~ _ ~ ___ Search i Applicant BWOfJ92fi33, Rotary Club of Dubuque, Dubuqu -= Applicant ,._---.__~,._ .~.~__ ....,..- ,...~._ ~-,~, __.m._ ~ ~ _ -,.~,,.~~~ ~ Transfer Premise After completion click on the NEXT link to continue to the next screen, or the BACK link to returr The navigation links on the top may also be used to move around the application. New Premise Location Information Applicant Signature Name of Applicant: l~~t~ Club C~$ L~~abuq~~e (Sole Proprietorship, t Name of Business {DIBlA}: F~ot~ry Club caf Dubuc{ue Dram Cert Address of Premise: 135 Vlj. ~3th St. Local Endorse Address Line 2: City: L~7ubuque County: Club~ici~~e Zip: 520Q1 Business Phone: X563} 58J-2234 Cell I H r Sasrre Address Mailing Address: F,O. E3ox 813 Mailing Address Line 2: City: I~~3ubuque zip: 52t304 Prev Phone: {86E} 469-2223 FAX: {515} 281-7375 Contact Name: Mike Phone: (563) 584-9235 Em https://eicensing.iowaabd.com/Applicant.aspx 08/28/2007 ABD Licensing -Transfer Premise Page 1 of 1 ~ Home ~~ +`~r 'f; ~ ~ _ ~ _ State Hof itt.wa ~~-~ ~ ~~ ~~,y~ I9~~~~= Contact Us "' s :_ - Logoff ~~ z~,- „~ ,, ?.. " ^s. ... ; W On-Demand Keg Registration Help License Search License List User Profile a._ Reporting __ ....Search ~ Appiicant Transfer Premise BW0092633, Rotary Club of Dubuque, I '~ Transfer Premise After completion click an the NEXT link to continue to the next screen, or the BACK link to return New Premise Location Information The navigation links on the top may also be used to move around the application. Applicant Signature Licenses may be transferred from one location to another, but only within the boundaries of the Dram Cert Transfer Application and all supporting documentation shall be approved by the Local Official ac Beverages Division before the event takes place. All selling and serving of alcoholic beverages r <~~ Local Endorse location during the period of the transfer. NOTE: if requesting a permanent transfer, an amendec Official. If requesting a temporary transfer, a (after of permission wiil be forwarded to the Local C Name of Applicant: Rotary Club of Dubuque Name of Business {D/B!A): Rotary Club of Dubuque Address of Premise: 135 W. 8th St. Address Line 2: City: Dubuque County: Dubuque New Premise Address: 1000 Jackson St New Premise Address Line 2: Dui~u ate ..,~...,wW,,._.-.,..,..e._._..~ State: City: q ~" lr~ti~~ !: Temporary Transfer {24 hours through 7 days) Beginning Date: 10/06/2007 r Prev Phone: {866) 469-2223 FAX: {515} 281-7375 f" Permanent Transfer Beginning Date: https://eicensing.iowaabd.com/TransferPremise.aspx 08/28/2007 ABD Licensing -New Premise Location Information Home i,~~~~~p}`i~ ~~ > ~tat~ cf to~.,~a ~ ~, ~>' ~I ~V~i~i~~hi ~ , Contact Us ~i~~ ~` ii'T' ~ ~:iW~ ~;'~ Logoff ~ .~ ~,, °'„_. .' ~ o ., ,,,, ..,.,_.. ,. .. ~`.._._____. ............,~ y,... On-Demand Keg Registration i Help License Search License List User Profile ~~.~...Reportmg _ ....__.....Search Applicant Transfer Premise New Premise Location Information ~ Applicant Signature Dram Cert Local Endorse .~.:. `- r~+i Page I of I New Premise Location Information BW0092fi33, Rotary Club of Dubuque, Dubuque After completion click on the NEXT link to continue to the next screen, or the BACK link to return to the previous screen. The navigation links on the top may also be used to move around the application. ~~ # of Bathrooms: ~ Number of floors where alcoholic beverages will be sold, served, consumed ar stared. Indicate how you have control of premises (Permanent Transfers Only}: C Own t"' Lease Submit to the Local Authority a signed copy of the leaselrental agreement far the license period signed final sales contract or warranty deed. Submit to the Local Authority a sketch on 8112 x 11"white paper of the proposed premises showing all areas and floors where alcoholic beverages will be sold, served, consumed and stored. Indicate all entrances and exits, location of bar, back bar and bathrooms. If Applicant ha< Outdoor Service Area Privilege, please include in the sketch its relationship to the licensed premises. Outdoor Service Area Dates (if From: MMIDD/YYYY Ta:~ MMIDDIYYYY applicable): Dates shall correspond with requested outdoor service areas. On-Premise Applicant's Only: Yes ~ is the premise furnished with tables and seats to accomodate a minimum of 2 persons at one time? ~.~. Prev Next Phone: (866} 469-2223 FAX: (515) 281-7375 https://eicensing. iowaabd. com/NewPremiseLocationInformation. aspx Terms of Servi Privacy Poli 08/28/2007 ABD Licensing -Applicant Signature Page 1 of 1 State pf Io~nra ~!""~' - ""_" ~ll~i ~ ...ix ~. Home ~ '~t ~~ ~~ ~ Contact Us ~ • + t~ * :1 ~. , Logoff ~ ~ •. ~ ~. ~ .1J. Helga....... ...License Search License List C~~-Uemand Keg Registration ~! User Praf~ie _Reportin Search_._._ _. _..___ .__. _. ____ _ _ g _ W._ _.._ _..... ....____ .._ _-. Applicant Applicant Signature BW0492633, Rotary Club of ,~ Transfer Premise Dubuque, Dubuque ~ New Premise Location Information _._____.___.____-- _.__ ___-_-~.~..____.__..__..~_ _..~ __~.___~....... _____._......-.....___._..~._______-~_...._.._ Applicant Signature Complete the information below and click Finish to complete the application Note that the license fees will only be withdrawn from accounts after the ASD approves the Dram Cert license. Local Endorse This application must be completed by a person listed in the Clwnership Section. I hereby declare that all information contained in the Application is true and correct. I understand that misrepresentation of material facts in the Application is a crime and grounds for denial of the license ar permit under Iowa law. I further understand that, as a condition of recieving a license, the licensed premise is subject to inspection during business hours by appropriate local, state and federal officials. NOTE: The Applicant's Name must match one of the owner's names from the Ownership screen. Applicant's Name: ~ar~~y ~~~~ Date: 0812iC~~37 MM/DD/YYYY Tentative effective date: ~ Q1~7~a;200 i MMIDD/YYYY Phone; (866) 469-2223 FAX: (515) 281-7375 Please print a capy of this page for your retards before clicking the "FINISH" button. ~~ Prev Terms of Service Privacy Policy https://elicensing.iowaabd.tom/ApplicantSignature.aspx 08/28/200